Telomeres have emerged as the true protagonists of this incredible science fiction story.

The key to determining how long we will live and how to prolong this time seems to reside in these regions of DNA that do not store information for the synthesis or creation of proteins, and that are located at the ends of our chromosomes. This is why, for the last few years, numerous researchers have focuses their attention on this point. And this is not surprising, because whoever manages to decipher the how and why of telomeric shortening will probably achieve the secret of eternal youth.

Dr. Moisés De Vicente – Neolife Medical Team

Telomeres are responsible for providing structural stability to our chromosomes.

How long will I live? Is there such a thing as eternal youth? Will I be able to be young again? These are questions that most mortals have pondered at some point in our lives, regardless of our nationality, ethnicity, gender or social status.

Life is a cycle that begins with birth and ends with death. We can decide what kind of life we ​​want to lead; we can even change our mind halfway through the game and turn our philosophy and routines of life around completely- like changing our socks. What we cannot do is know how long we will be here for, or if anything we do will prolong that time …. or can we?

The normal healthy cells of our body are not capable of dividing infinitely. This fact is known as the “Hayflick limit” in honor of Leonard Hayflick, founding member of theNational Institute on Agingand a scientist who, in 1962, was able to prove this. Therefore cells have a limited lifespan. And what does this lifespan depend on? On certain structures called telomeres.

Telomereshave emerged as the true protagonists of this incredible science fiction story. These are non-coding regions of DNA, i.e they do not store information for the synthesis or creation of proteins, and they are located at the ends of ourchromosomes.

And if they don’t intervene in the production of proteins, what are they for? Their function is unique: they are responsible for providing structural stability to our chromosomes. They are like the plastic sheaths (known as aglets) fitted to the ends of shoelaces . Without them, the laces would fray and break. The same thing happens with DNA.

In this way, their activity is closely related to two basic events of the cell cycle: division and the lifetime of the different cell lines. As the cellsdivide, the telomeresare progressively shortened. On reaching a certain point of shortening, the telomeres will not be able to maintain their stabilizing function, and the chromosomes will begin to divide erroneously, leading to alterations and mutations that will cause the cell to destroy itself,by a mechanism of self-destruction or “apoptosis”.

In the light of this, the key to determining how long we will live and how to prolong this time seems to reside in these small areas of our chromosomes. This is why, for the last few years, numerous researchers have focuses their attention on this point. And this is not surprising, because whoever manages to decipher the how and why of telomeric shortening will probably achieve the secret of eternal youth.

Recently a new step has been taken in this direction. Researchers at the University of Arizona, led by Professor Julian Chen, have unraveled one of the crucial steps in the catalytic metabolism of thetelomerase enzyme (1). This enzyme is responsible for synthesizing and placing a series of nucleotide repetitions (base pairs) that will be inserted at the ends of the chromosomes, so that their shortening can be prevented (2). This enzyme is responsible, so to speak, for laying the “bricks” that make up the telomeres. It will therefore be the one that will determine at what speed they are shortened, and therefore the one responsible for defining how fast we grow old.

Theoretically, if we manage to make this enzyme continue to place base pairs at the chromosomal ends at the appropriate speed, it would be possible to lengthen these areas. In this way, the destabilization of the chromosome would be avoided and, as a consequence, the cells would not have to self-destruct, thus increasing their lifespan.

For the telomerase enzyme to perform its function correctly, the “bricks” need to be placed in certain positions. For this there is a braking system that enables it to have sufficient time to perform its function. However, this very system is the limiting step that will determine the speed at which the enzyme can work. By achieving a way to make this braking system less rigid, we could turn the dream of lengthening thetelomeres into a reality.

Meanwhile, we now know that there are a series of conditions and activities that slow downtelomeric shortening : having a healthy diet with low caloric intake; performing physical exercise regularly and intensively; avoiding toxic habits such as tobacco and alcohol; undergoing, if appropriate, a correct hormone replacement therapy; and the regular consumption of certain antioxidant nutritional supplements(such as turmeric) and vitamins (3). In fact, drugs have already been studied, such as TA-65, which seem to be able to provide this benefit (4).

AtNeolife we are strong advocates of aquality aging. We seek and prevent the diseases associated with aging and treat our patients so that they can achieve very long lifespans with the fullest and best quality of life possible.

In addition, we have the possibility of measuring thetelomere lengthof our patients. With this we are able to estimate the biological cell age that they have and, with this, suggest more demanding treatments depending on the result. In addition, we can verify how theanti-aging program is giving results.

BIBLIOGRAPHY

(1) Chen, Y., J.D. Podlevsky, D. Logeswaran and J.J.-L. Chen (2018). A single nucleotide incorporation step limits human telomerase repeat addition activity. EMBO. J. 37: e97953, DOI: 10.15252/embj.201797953.

(2) Li, Y., Pan, G., Chen, Y., et al. Inhibitor of the human telomerase reverse trancriptase (hTERT) gene promoter induces cell apoptosis via a mitochondrial-dependent pathway. Eur J Med Chem. 2018 Feb 10; 145:370-378.

(3) Pan, MH., Wu, JC., Ho, CT. Effects of water extract of Curcuma longa (L.) roots on immunity and telomerase function. J Complement Integr Med. 2017 May 12;14(3).

(4) Salvador, L., Singaravelu, G., Harley, C. A Natural Product Telomerase Activator Lengthens Telomeres in Humans: A Randomized, Double Blind, and Placebo Controlled Study.Rejuvenation Res. 2016 Dec;19(6):478-484.

La entrada Are we facing the secret of eternal youth? se publicó primero en Neolife.

Low testosterone levels can lead to weight gain and an increase in visceral fat, whilst obesity, in turn, can lead to a decrease in testosterone levels.

The relationship between obesity and testosterone deficiency is, therefore, bidirectional. And both factors correlate with the onset of cardiovascular diseases, oncological diseases and an increase in overall mortality. Are there any solutions? Follow a personalized and effective nutritional program that ensures you do not stray into obesity, as well as a bioidentical hormone treatment that will restore low testosterone levels to a normal level once again.

Dr. Moisés De Vicente – Neolife Medical Team

Testosterone deficiency and general obesity correlate to an increase in mortality independent of each other but there is also an inversely proportional relationship between them.

A homeostatic balance is one of the fundamental elements necessary for us to age gradually and maintain our quality of life. To achieve this it is necessary to ensure our body is ready, as if the body was a clock. Two of the pillars on which we must focus are obesity and hormonal imbalance.

The overweight epidemic suffered in most developed countries is well known to all of us. Our lifestyles and diet have lead us, inexorably, to the weight we all gain at some point in our lives and, in some cases, some of us appear to gain weight indefinitely. But this increase in weight does not only imply a physical deterioration. Obesity is clearly related to the onset of cardiovascular and oncological diseases and an increase in mortality risk (1).

On the other hand, a hormonal deficiency typically begins to present in people aged 35-40. In the case of men, this decline is typically associated with a decrease in testosterone levels. It has been estimated that up to 38.7% of men have insufficient testosterone levels by the age of 45.

Testosterone acts in a number of basic physiological events within our body. Not only does testosterone improve physical activity and sexual quality, but it also acts on muscle development allowing us to maintain an adequate weight and even prevent cognitive deterioration (2). As with obesity, a decline in testosterone is related to the onset of cardiovascular and oncological diseases and with an increase in overall mortality (3).

Such evidence when viewed in isolation warrants a special mention irrespective of the correlation which is known to exist. It is for this reason we consider it interesting how these two conditions do not seem unrelated. There is an inversely proportional relationship between the onset of obesity and testosterone deficiency. But, let us not forget this relationship is also bidirectional. That is to say, on the one hand, low testosterone levels can lead to weight gain and an increase in visceral fat whilst, on the other hand, obesity can lead to a decrease in testosterone levels (4). Now, the reason for this dualism is something that has not been clarified to date.

It is conjecture at this time that the presence of these two conditions increases the mortality even more than they would independently. For this reason, a study published in Clinical Endocrinology has been designed to answer this question directly.

The study included more than 1,500 men aged 20 and over who did not have any known cardiovascular disease or prostate cancer. During the study testosterone levels in the blood were taken. Participants were also given a nutritional questionnaire and their weight, height and abdominal girth were measured before their body mass index was calculated. A follow-up was conducted 9.5 years later.

The results confirmed what had already been demonstrated in other publications: that a testosterone deficiency by itself, and independent of other variables could be linked to a higher mortality risk. Likewise, the presence of this deficiency has also been associated with abdominal obesity, which in turn has been shown to correlate with an increase in mortality (Figure 1).

However, the relationship between testosterone deficiency and general obesity has not yet reached a sufficient level to be able to categorically confirm that chances of survival decrease as a result of the relationship. As it has been published in different studies, it seems that testosterone acts mainly on visceral fat, which typically manifests in the presentation of abdominal obesity. And it is this visceral fat that could be responsible for the onset of the different pathologies listed at the beginning of the article. As a result, we can now understand that the relationship that clearly links to the deaths is this, and not general obesity.

In light of these results, it is evident that the cocktail of testosterone deficiency and abdominal obesity is dangerous and we should focus our efforts on correcting the underlying issues. And here is where we discover another important element: correcting only one of the issues in isolation may not be enough to achieve the desired objective. In the long term, an unresolved testosterone deficiency will make it increasingly difficult to lose weight, and this, in turn, will increase the testosterone deficiency.

This then creates a vicious circle that is very difficult to break with conventional medicine. Taking into account that mortality is greater if a patient presents with these two characteristics, it is essential that we take steps to shuffle the deck in some way. And sometimes, to shuffle the deck it is necessary to put a fist through the table.

At Neolife we push against the obesity trend by encouraging patients to adhere to a program of personalized nutrition and many achieve excellent results. In addition to this, we are pioneers in the use of hormone treatment using bioidentical hormones. We carry out a comprehensive assessment and measure testosterone levels and rebalance the latter where necessary.

Thanks to this program -where we use different strategies, but all of them perfectly connected-, we are able not only to improve the quality of life of our patients, but also to decrease their mortality risk. By utilizing this program we are able to get our patients to take a key step towards breaking the deadly cocktail.

BIBLIOGRAPHY

(1) Global BMI Mortality Collaboration, Mortality C, Di Angelantonio E, et al. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet. 2016;388:776–786.

(2) Khera M, Adaikan G, Buvat J, et al. Diagnosis and treatment of testosterone deficiency: recommendations from the fourth international consultation for sexual medicine (ICSM 2015). J Sex Med. 2016;13:1787–1804.

(3) Platz EA. Low testosterone and risk of premature death in older men: analytical and preanalytical issues in measuring circulating testosterone. Clin Chem. 2008;54:1110–1112.

(4) Kelly DM, Jones TH. Testosterone and obesity. Obes Rev. 2015; 16:581–606.

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This is based on the concept that precision medicine can be applied to improve individual well-being. The concept combines the study of the genome with a diverse range of biochemical and microbiological data.

The ability to integrate the information that our biomarkers provide us with our genetic information can be crucial in initiating a specific preventative treatment or attempts to improve our health. For example, this concept would be essential to a program which sought to improve the glycemic profile in cases where our genes show that a specific type of individual or group have a propensity to suffer from diabetes.

Dr. Moisés de Vicente – Medical Director Neolife Madrid

A study published in the Nature Biotechnology journal suggests that the continuous collection of personal biological data can improve our understanding of health and diseases.

Each person is unique and in essence is unrepeatable. Not only on an intellectual level but also on a sentimental and ‘way of being’ level. Each individual contains an immense amount of biological data that make us different from each other. This data set includes our genomic information, metabolites, proteins, microbiome composition, etc. The interaction of all these systems that coexist in our body, and how they react to external or internal aggression, is what will determine our disease state (human condition). In this way, if we could understand the data in greater detail, as well as the intrinsic relationships which exist between them then we could obtain some crucial information to allow us to preserve our health. This concept is the basis for the 100 Wellness Project, whose preliminary results have recently been published in the Nature Biotechnology journal and suggest that the continuous collection of personal biological data can improve our understanding of health and diseases. The researchers collected all types of data (genomic, biochemical and personal) from 108 patients over a period of 3 months. Also, through the use of digital instruments they collected and quantified details from their daily activities. The results obtained focused on four types of diseases that are related to aging: cardiovascular risk, malnutrition, diabetes and inflammation. They used powerful analytical tools which allowed them to integrate all the information together. This process is known as “Scientific well-being” which is a new concept that precision medicine can be applied to improve individual well-being. The concept combines the study of the genome with a diverse range of biochemical and microbiological data. Such a process enables us to integrate the information that our biomarkers provide us with our genetic information that can be crucial to, for example, initiating a specific treatment or program in order to improve our glycemic profile in cases where our genes show that there is a propensity for the patient in question to suffer from diabetes and our markers do not yet meet the criteria established by the different societies to provide a definitive diagnosis. At Neolife we use a significant amount of biomarkers which allows us to establish the health status of our patients. In addition to this, we conduct genetic studies that allow us to establish the likelihood that a chosen person may suffer a disease. Then using this knowledge we carry out preventive medicine programs that allow us to optimize our parameters in the most efficient way in order to avoid the occurrence of subclinical injury, or, if this is already present, to delay the progression to the greatest extent possible.

BIBLIOGRAPHY

(1) Price ND, et al. A wellness study of 108 individuals using personal, dense, dynamic data clouds. Nat Biotechnol. 2017 Jul 17. doi: https://dx.doi.org/10.1038/nbt.3870 (2) Institute for Systems Biology and Arivale “Pioneer 100 Study” Establishes Foundation for New Industry of Scientific Wellness. https://www.systemsbiology.org/news/2017/07/17/pioneer-100-study/ (3) Cross R. Scientific wellness’ study—and a famed biologist’s spinoff company—divide researchers. 2017. Doi: https://dx.doi.org/10.1126/science.aan7123

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Over the last few years we have witnessed a continuous development in terms of technology that makes the devices flexible, precise and, above all, very comfortable to use.

These devices, approved by the FDA, allow the diabetic patient the possibility of freeing themselves from the slavery of the annoying finger pricks. But they are not only useful for people who already suffer from diabetes: in the case of pre-diabetic patients these devices allow individuals to better understand the potential risks of developing the disease in the future.

Dr. Francisco Martínez Peñalver – Medical Director Neolife Marbella

Freestyle Libre (Abbot) and G5 (Dexcom) are the first implantable meters for continuous measurement of plasma glucose

According to WHO, in the next 10 years we will see a dramatic rise in the prevalence of type 2 diabetes. It is logical, then, to produce devices that make life easier for those who already fall within this category. Both type 1 and type 2 quality of life surveys report that the action that most limits patients ability to maintain a quality of life is the taking of peripheral glycemia through a prick in the finger 4-7 times a day.

For some years now we have witnessed the appearance of implantable meters that allow patients to continually measure plasma glucose. Recent developments in terms of technology have meant that the devices are now flexible, precise and, above all, very comfortable to use.

The first to arrive in our country was the Freestyle Libre, from Abbot laboratories. This device includes a disposable patch that is implanted in the patient’s arm, which allows continuous monitoring and consultation for a two week period, allowing the patient to record their glucose values as often as they wish. This patch is accompanied by a measuring device to interpret the signal that the patch emits. It also allows the measurements to be supported using the classic prick on the finger and the corresponding test strip. At the end of the two week period, the meter is synchronised with the computer and comprehensive reports are generated about the patient’s glycemic patterns, including an insulin readjustment option.

On the other hand, the first device to be launched was the G4, which has been recently replaced by the newly developed G5, both by Dexcom. The replacement device does cost more than the previous model as it includes the manufacturer’s nursing service that helps the patient adapt to the new device. The meter is implanted subcutaneously in the abdomen and connects automatically to a smartphone, making any additional meter unnecessary.

In favour of continuous monitoring devices: increased comfort when compared to pricking the finger for continuous monitoring. Against: the cost.

In both cases, the G5 and Freestyle, allow the diabetic patient the possibility of freeing themselves from the slavery of the annoying finger pricks. The devices also reveal patterns in the glucose, allowing the patient to be warned about the risk of hypo- or hyperglycemia and assisting them to avoid the frustration of nocturnal hypoglycemia that can both awaken and scare patients. These devices are approved by the FDA and can be used as part of the nutritional education of the patient, since they themselves will be able to observe the direct response of their hydrocarbon metabolism to the intake of certain foods. Notwithstanding these advancements there are some arguments against the devices. The principal argument against is the price; although countries such as the Netherlands or Denmark do provide them as part of treatment on their respective public health services, they are devices that, for the general public, can be expensive, considering that we are talking about an expense that will be fixed for the rest of the patient’s life. On the other hand, patients may become obsessed with the possibility of knowing their glycemic values ​​at all times and perform countless unnecessary measurements. In summary, the continuous glucose monitoring devices are not science fiction, but are already among us with varying degrees of accessibility. At Neolife, as part of our comprehensive health prevention approach in our health awareness programs we provide patients who require them, access to this technology, not only to help the diabetic patient, but so that the euglycemic patient can better understand the potential risks of developing the disease in the future.

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There are multiple methods for measuring body fat: bioimpedantiometry, dual-energy x-ray absorption, plicometry (using skinfold calipers), morphological imaging study etc.

For years researchers have debated about the best way to determine body composition. Although there are more modern and precise methods which can be used each technique has important advantages and disadvantages which should be noted. That is why the ideal method for determining body composition is one that relies on all of the methodologies to produce a joint assessment.

Tania Mesa – Nutritionist and Nurse from Neolife

There are a number of different methods which can be used to measure fat mass and lean body mass with varying levels of precision.

Losing weight does not always mean that you are losing weight in the right way. It is necessary to know the amount and location of body fat tissue, since having a high percentage of fatty tissue increases the risk of developing cardiovascular diseases, diabetes, hypertension and certain types of cancer.

Being thin does not necessarily mean you must have a lower body fat percentage than thinner people, since the latter may simply be more muscular. It may also be the case that you have gained muscle mass when training hard, without noticing any variation on the weighing scales.

For years researchers have debated the most accurate way to measure body fat. The weighing scale is the conventional and simplest method as it provides an indication of weight; however, the scales cannot provide information on the amount of fat, which is why we must resort to more precise technologies.

At Neolife when starting a weight loss program (in conjunction with an exercise program), we need to understand a priori the body composition of our patients, that is to say, the amount of lean mass (muscle, bones and viscera) and fat mass in your body. In order to do this we measure and monitor their progress during consultations using a number of different methods:

Body composition using multifrequency octopolar impedantiometry.

The multifrequency octopolar impedantiometry scales are equipped with a high-frequency signal generator and precision detector. An electric current with very low intensity, totally imperceptible that does not represent any danger to the patient, passes through the body allowing us to evaluate the resistance of the body tissues. The resistance depends on the water contained in the tissue, which has a constant proportion in the muscle mass. Specifically, 73% of muscles is water. This data, together with the patient’s sex, age and height allow us to calculate the muscle mass of the entire body. The fat mass act as an insulator (as such fat does not conduct electricity), so it is not measured directly.

However, this method may still provide variable results from several measurements, mainly in cases where the individual concerned is adversely affected by the effects of any action that may modify the body’s water levels. This would be the case for those with an edema in the lower limbs, fever, persons currently taking diuretics etc. or performing the test immediately after drinking liquids (water, alcohol etc.), after eating a meal or after a period of intense exercise (we can lose between 1 and 2 kilos of water, which will be recovered in the 24 hours that follow exercise). Also some women experience a cyclic variation of weight due to menstruation, during which the volume of liquids in several kilos can increase. Misleadingly, the percentage of fat decreases temporarily, due to an increase in the total weight.

Body composition using dual-energy x-ray absorption (DXA).

DXA is the most accurate clinical device, the so-called “gold standard” of body composition measurement. This is considered the most reliable method for measuring body fat. This method determines the corresponding weights and percentages of fat, bone and lean tissue. The sum of the three tissues is the total mass. Additionally, the body is segmented into different regions (arms, torso, legs etc.), allowing us to assess the specific location of excess fat or muscle tissue and develop a weight loss program or similar schedule to tone the body.

The normal range for fat percentage is very broad and depends on the reference population used. As such if the reference population are elite athletes (1), catwalk models or representatives of a healthy adult population then the normal range be altered accordingly.

One of the greatest benefits of DXA (2) is that the method allows us to evaluate the distribution of android fat and gynoid fat – as these represent the best risk predictors for health.

The healthy objective we strive towards at Neolife is that women have a fat percentage below 30% and men below 25%. However, your objective may vary depending on other criteria not related to your health such as body image (aesthetics) or physical performance factors.

Anthropometry.

Anthropometry is the most used method in Sports Medicine. It is based on the measurement of skin folds using a caliper known as a “skinfold caliper”, as well as a number of different perimeters and diameters. It is necessary that the measurements be taken by an expert in the field (anthropometrist).

By using these anthropometric determinations and applying a series of formulas, the expert can calculate the body composition and somatotype of the individual concerned. The measurement and examination over time of fat folds, their total measurement and circumference can accurately record the anthropometric changes of a body.

The fold curve for cutaneous fat can provide valuable information on the magnitude and distribution of subcutaneous fat. However, this only provides localized, not extensive, body fat data. In addition, it is not useful for measuring skin folds in obese people.

Morphological image study (photographs).

The morphological image study allows us to observe subtle changes in body shape, body volume and postural habits, which are difficult to appreciate using the previous techniques when assessing body composition.

At the Neolife clinic we use all body composition measurement techniques in a combined fashion to take advantage of the benefits each can provide.

There are many different methods for determining body composition and each of them has their own distinct advantages and disadvantages. For this reason, at Neolife, during the clinical checks we carry out as part of our nutritional consultations, we use all of the above mentioned techniques to measure the body composition of the individual concerned. When used together the techniques can be used to provide us with very accurate information, and enable us to establish nutritional recommendations, personalized diets and training schedules.

BIBLIOGRAPHY

(1) Bilsborough JC, Greenway K, Opar D, Livingstone S, Cordy J, Coutts AJ. “The accuracy and precision of DXA for assessing body composition in team sport athletes”. J Sports Sci.2014;23(19):1821-8.

(2) Ulbricht L, Neves EB, Ripka WL, Romaneli EF. “Comparison between body fat measurements obtained by portable ultrasound and caliper in Young adults”. Conf Proc IEEE Eng Med Biol Soc.2012;2012:1952-5.

La entrada How is body composition measured? se publicó primero en Neolife.

According to a recent study, it is not only important that your current BMI is normal, it is also important that your BMI has never been elevated.

After analyzing more than 6,000 subjects, the study demonstrated that mortality risk does increase in two distinct ways; where there is an increase in the current BMI and where the BMI has increased previously during the subject’s life. The latter risk was more pronounced than the former.

Neolife medical management

Being overweight and obese in the past can often leave lasting effects on our body, just like tobacco does in ex-smokers.

We know that being overweight and obesity often correlate with a greater morbidity-mortality risk. Nevertheless, until recently there have been few studies that have evaluated the fact that if you were previously obese but are no longer obese then your body will still bear evidence from your previous obesity. In a recent and interesting study published online in the Proceedings of the National Academy of Sciences journal (1) it has been shown that if you have previously maintained a high body mass index (BMI) throughout your life then this can be a mortality predictor that is more accurate than your current BMI. For example, if 5 years ago a person was classified as obese type II (with a BMI of 35 Kg/m2), but currently has a normal weight (with a BMI of 24 Kg/m2), their risk of mortality remains high, even above other obese type II people who currently have a BMI of 35.

The study analyzed data from 6,276 subjects aged between 50 and 74 years old provided through US national health and nutrition surveys. (NHANES) between 1988 and 2010. Of the above subjects, 875 died within an average follow-up period of 8 years.

39% of the respondents had lost weight having been overweight or obese and were considered to be at a normal weight at the time of the survey. The risk of mortality was calculated by reference to two models, the first based on the subject’s BMI at the time of the survey and the second on the maximum BMI that the subject would have had throughout their life. It was observed that both in model 1 and model 2 the ratio relating to the risk of mortality increased alongside weight, but model 2 showed a more pronounced risk. That is to say, past obesity can leave a mark.

Comparative table: risk ratios based on current BMI and maximum BMI.[/ caption]

Does this mean that weight loss is bad? The answer is NO. What this study shows is that the after-effects of having been obese in the past are not completely erased even if you have lost weight and your BMI is now considered normal. It is somewhat similar to what happens with smokers: having been a smoker in the past they retain the risk of illness and remain at risk of an early death. But then, why do those who have lost weight maintain a greater risk than those who have not lost weight? The reason is that those who have lost weight have not done so voluntarily for the purposes of risk prevention but because their poor health forced them to lose weight. That is to say, they started from a worse state of health than those who remained obese.

In conclusion, not only is it important that your current BMI is normal, it is also important that your BMI has never been elevated. This data is important when it comes to how best to avoid weight gain: it is not desirable to think that we can gain weight because we are certain that in the future we will lose the weight gained. The time that we spend overweight or obese can leave a lasting mark on our health, in the same way that we often see with ex-smokers.

BIBLIOGRAPHY

(1) Proc Natl Acad Sci USA. Published online January 4, 2016.

https://www.pnas.org/content/113/3/572.abstract

La entrada Being obese and overweight in the past can leave a mark se publicó primero en Neolife.

A recently published study has strengthened the predictive value in disease and death where the waist/hip ratio (WHR) is greater than the BMI.

The study concluded that even if we have a normal weight according to the body mass index (BMI), if the waist/hip ratio is high then the risk of dying from cardiovascular disease increases by 87% in men and 48% in women.

A person with a normal BMI and a high WHR doubles their risk when compared to a person with an elevated BMI and normal WHR.

Tania Mesa – Nutritionist and Nurse from Neolife

The important consideration is not your BMI, but the amount and location of the body fat.

At Neolife we have a wealth of experience in carrying out anthropometry and body composition assessments. For this reason we have understood for a long time that the body mass index (BMI) is a value that is only indicative of a person’s weight by reference to their height: the index does not take into account what component is contributing to the weight, if the weight is fat, water, muscle etc. Typically a high BMI score is indicative of fatty tissue, but on occasion, although rarely the case, the weight is due to an excess of lean mass or fat-free mass (muscle, water etc.). You only have to see the BMI of professional athletes to understand that some of them could be classified as obese, when their percentage of fat is in reality normal. Their muscle mass is the main component of their weight and, as a result, they have no greater risk of developing any of the diseases normally associated with overweight or obesity.

For more than 40 years, medical institutions and scientific societies have classified an individuals weight according to their BMI, when it should really be based on the body fat percentage. And if we were more strict in our approach, the location of the body fat; specifically whether or not the fat is located in the intra-abdominal area, that is to say, around the abdominal viscera.

Classification of weight according to BMI*

Some medical authorities classify overweight and obesity by reference to the individuals fat percentage in accordance with the following criteria:

• Men
  • Overweight where the fat percentage is between 21 and 25%
  • Obesity where the fat percentage is above 25%

• Women
  • Overweight where the fat percentage is between 31 and 33%
  • Obesity where the fat percentage is above 33%

However, there is no general criterion for the classification of overweight and obesity according to the fat percentage or even how best to measure the same (plicometry, impedantiometry, DXA etc).

A new study (a different study) published in the Annals of Internal Medicine (1) further reinforces the predictive value in disease and death where the waist/hip ratio (WHR) is greater than the BMI. The authors found that a high WHR with a normal BMI is likely to cause an increase in the risk of disease and early death, particularly in relation to cardiovascular causes. The accumulation of intra-abdominal fat or visceral fat is a genuine risk factor. Fat that accumulates in the abdomen is not the same as fat on the legs or hips.

The study analyzed data from the NHANES III health survey (Third National Health and Nutrition Examination Survey) conducted on 15,184 people (52.3% women) between the ages of 18 and 90 over a period of more than 14 years. The study concluded that even if we have a normal weight according to the body mass index (BMI), if the waist/hip ratio is high then the risk of dying from cardiovascular disease increases by 87% in men and 48% in women. A person with a normal BMI and a high WHR doubles their risk when compared to a person with an elevated BMI and normal WHR.

In the editorial article in the same journal (2), Dr. Poirier discusses the usefulness of different techniques as a means to quantify abdominal obesity and recognizes that, although BMI is not the ideal technique when BMI is used together with waist circumference and/or the hip-waist ratio that it is the most appropriate technique in a clinical setting.

The simplest way to measure an accumulation of intra-abdominal fat is with a tape measure. You can simply measure the waist circumference to discover whether or not the individual concerned has a value greater than 80 cm (for women) and 94 cm (for men) that would be considered high (according to the IDF criteria, International Diabetes Federation). However, the WHO criteria is more relaxed: stating greater than 88 cm for women and 102 cm for men. Another way to assess intra-abdominal fat is to calculate the ratio between waist circumference and hip circumference and compare the ratio to the WHO criteria which states that a waist/hip ratio is high if the value is greater than or equal to 0.85 in women and 0.9 in men.

The ideal quantification technique to use for intra-abdominal fat remains the CAT scan (computerized axial tomography) and MRI (magnetic resonance imaging) but they are not useful in day-to-day clinical practice due to their cost, duration and radiation (in the case of a CAT scan). The intermediate alternative is DXA (dual-energy x-ray absorptiometry), which is the most sophisticated means of measuring body composition in a clinical setting. However, although this allows us to quantify fat in a certain region of the abdomen this method does not allow us to distinguish between visceral fat and subcutaneous fat within the defined area. And one must also note that there are no reference values.

At Neolife we perform a complete anthropometric assessment, which includes the following:

• BMI Calculation
• Determination of the waist circumference (WHR)
• Anthropometry using measurements from 6 fat folds, perimeters and diameters
• Multifrequency octopolar bioimpedantiometry
• DXA
• Morphological image assessment (technical photographs)

By combining all of these methods we have the best available clinical approach to anthropometric assessment as the results inform us in a very exact way about the risk(s) that excess weight can have on our health.

At Neolife we have extensive experience in carrying out body assessments

Below we have provided a few real-life cases from Neolife patients using a profile simulator based on their BMI and the image obtained of them through DXA:

Patient nº1 (man)

• BMI: 30.5 (obesity I)
• Waist: 95.4 (normal according to WHO)
• WHR: 95.4/106.5 = 0.89 (normal according to WHO)
• Total fat % from DXA:  22.1 (overweight)
• Abdominal region fat % from DXA: 27.9%
• Example of a high BMI with a not significantly high fat percentage, a normal waist circumference, a normal WHR and normal abdominal region fat percentage.
• OBESE ACCORDING TO BMI, INTRA-ABDOMINAL FAT NOT ELEVATED, CARDIOVASCULAR RISK NOT ELEVATED

Patient nº2 (man)

• BMI: 31.9 (obesity I)
• Waist: 112 (elevated according to WHO)
• WHR: 1.01 (elevated according to WHO)
• Fat % from DXA:  31.5 (obesity)
• Abdominal region fat % from DXA: 43.3%
• Example of a high BMI with a high fat percentage, elevated waist circumference, elevated WHR and high abdominal region fat percentage.
• OBESE ACCORDING TO BMI, INTRA-ABDOMINAL FAT ELEVATED ACCORDING TO DXA AND WHR, ELEVATED CARDIOVASCULAR RISK

Patient nº3 (male)

• BMI: 29.1 (grade 2 overweight)
• Waist: 93 (normal according to WHO)
• WHR: 0.9 (upper limit according to WHO)
• Fat % from DXA:  34.5 (obesity)
• Abdominal region fat % from DXA: 43.4%
• Example of a non-obese BMI with a high fat percentage, elevated waist circumference, elevated WHR and abdominal region fat percentage.
• NOT OBESE ACCORDING TO BMI, INTRA-ABDOMINAL FAT ELEVATED ACCORDING TO DXA AND WHR, ELEVATED CARDIOVASCULAR RISK

Patient nº4 (woman)

• BMI: 29.3 (grade 2 overweight)
• Waist: 94 (elevated according to WHO)
• WHR: 0.93 (elevated according to WHO)
• Total fat % from DXA: 41.9 (obesity)
• Abdominal region fat % from DXA: 50.2%
• Example of a non-obese BMI, with a very high fat percentage, elevated waist circumference, elevated WHR and very high abdominal region fat percentage.
• NOT OBESE ACCORDING TO BMI, INTRA-ABDOMINAL FAT VERY ELEVATED ACCORDING TO WHR AND DXA, ELEVATED CARDIOVASCULAR RISK

Patient nº5 (female)

• BMI: 38.6 (GRADE II obesity)
• Waist: 92 (elevated according to WHO)
• WHR: 0.72 (normal according to WHO)
• Fat % from DXA:  51.9 (obesity)
• Abdominal region fat % from DXA: 51.2%
• Example of an obese BMI, with a very high fat percentage, elevated waist circumference, elevated WHR and very high abdominal region fat percentage.
• OBESE ACCORDING TO BMI, INTRA-ABDOMINAL FAT VERY ELEVATED ACCORDING TO DXA BUT NOT ACCORDING TO WHR, ELEVATED CARDIOVASCULAR RISK

Patient nº6 (woman)

• BMI: 24.5 (normal weight)
• Waist: 75.5 (normal)
• WHR: 0.7 (normal according to WHO)
• Fat % from DXA:  33.4 (obesity)
• Abdominal region fat % from DXA: 32.5%
• Example of a normal BMI, with a high fat percentage, a normal waist circumference, normal WHR and a normal abdominal region fat percentage.
• NORMAL WEIGHT ACCORDING TO BMI, HIGH TOTAL FAT PERCENTAGE, INTRA-ABDOMINAL FAT NORMAL ACCORDING TO DXA AND WHR, NORMAL CARDIOVASCULAR RISK

Patient nº7 (woman)

• BMI: 29.8 (overweight)
• Waist: 87 (elevated)
• WHR: 0.79 (normal according to WHO)
• Fat % from DXA: 47 (obesity)
• Abdominal region fat % from DXA: 48%
• Example of a non-obese BMI, with a high fat percentage, elevated waist circumference, a normal WHR and high abdominal region fat percentage.
• OVERWEIGHT ACCORDING TO BMI, HIGH TOTAL FAT PERCENTAGE, INTRA-ABDOMINAL FAT NORMAL ACCORDING TO DXA AND WHR, NORMAL CARDIOVASCULAR RISK

BIBLIOGRAPHY

*Source: Spanish Society for the Study of Obesity (SEEDO 2007)

(1) Sahakyan, K., Somers, V., Rodriguez-Escudero, J.P. et al “Normal-Weight Central Obesity: Implications for Total and Cardiovascular Mortality” Ann Intern Med. Published online 10 November 2015 doi:10.7326/M14-2525

https://annals.org/article.aspx?articleid=2468805

(2) Poirier, P. “The Many Paradoxes of Our Modern World: Is There Really an Obesity Paradox or Is It only a Matter of Adiposity Assessment?” Ann Intern Med. Published online 10 November 2015 doi:10.7326/M15-2435.

https://annals.org/article.aspx?articleid=2468808

La entrada The BMI (body mass index) has fallen out of favor se publicó primero en Neolife.

According to a recent study, a healthy 45-year-old person has a 45% chance of developing prediabetes and 31% of having diabetes in the future.

The key to preventing diabetes lies in monitoring the hydrocarbonated metabolism through continuous measurement of three essential biomarkers: blood glucose, glycosylated hemoglobin and insulin. The objective of Age Management Medicine is to achieve values ​​of excellence across all of the biomarkers, which in practical terms means that those biomarkers associated with the development of said disease need to be reduced to almost zero.

Neolife medical management

Any deterioration in your hydrocarbonated metabolism may not only lead to the onset of diabetes but it may also cause heart attacks, or the onset of Alzheimer’s and cancer in the future.

Any impairment to your glucose metabolism at a previous time in your life is likely to be relevant to your present health so the strategies we propose to our patients are provided in an attempt to control and prevent this type of deterioration. We recommend that such plans be implemented as soon as possible, irrespective of their general health condition.

Any deterioration in your hydrocarbonated metabolism (of glucose) across any of the different levels (normal, prediabetes, type 2 diabetes, use of insulin) is considered to be one the “men of the apocalypse” and an omen in terms of your health. Such changes tend to indicate that the patient may present with potential cardiovascular disease (heart attack, hypertension, stroke), cancer or a neurodegenerative disease (mainly Alzheimer’s) in the future. In reality all of these diseases form part of the ageing process and are arguably therefore related to each other. Notably the deterioration of your glucose metabolism and the onset of diabetes can lead to all the other problems (heart attack, Alzheimer’s disease and cancer). That is why the monitoring and control of the glucose metabolism is so important.

This aspect has been further investigated by the authors of a magnificent study recently published in Lancet (1), in which the risk of developing prediabetes and diabetes has been studied throughout life. The data was obtained from 10,050 participants who participated in the Rotterdam Study and the follow-up period of approximately 15 years. Of the total participants, 1,148 developed prediabetes, 828 developed diabetes and 237 required treatment with insulin. The criteria by which the participants were classified into the different groups were those applied by WHO and are listed as follows:

• Normal: fasting glucose below 108 mg/dL
• Prediabetes: fasting glucose between 108 mg/dL and 125 mg/dL
• Diabetes: glucose above 125 mg/dL

The study calculated that the risk of a healthy person aged 45 developing prediabetes throughout the rest of their life was nearly 50%, whilst the risk of developing diabetes was 31% and of 9% that they would require insulin. People who are already prediabetic at 45 have a 74% risk of becoming diabetic and nearly 50% risk that they will have to use insulin for the rest of their lives. The above risk percentages decrease with age as there is less time to live (and consequently develop the disease) or increase in weight to a level deemed to be overweight.

At the Neolife anti-ageing clinic we closely monitor your hydrocarbonated metabolism (even several times a year) and we do not solely rely on fasting glucose. We also measure your glycosylated hemoglobin and insulin levels. Our application of Age Management Medicine also includes reference ranges to help us better understand the biomarker values. Our objective is to achieve values ​​of excellence across all of the biomarkers, which in practical terms means that those biomarkers associated with the development of said disease need to be reduced to almost zero. All these biomarkers which relate to hydrocarbonated metabolism can be correlated with the risk of developing diabetes and the subsequent cardiovascular, renal, retinal and neurological complications, as well as a reduced level of hope and quality of life.

It is necessary to monitor the glucose, glycosylated hemoglobin and insulin to determine the relative success of the prevention measures undertaken.

Fasting glucose level is an essential biomarker in the diagnosis of diabetes: a value above 125 mg/dL indicates the individual has a high risk of suffering from diabetes in the future; if this parameter is between 108 and 125 mg/dL, then the level is typically indicative of prediabetes; on the contrary, a value below 90 mg/dL is optimal and serves to protect the individual from cardiovascular disease.

The hemoglobin A1C (HbA1C) or glycosylated hemoglobin or glycated hemoglobin is an excellent “whistle blower” and can highlight a diet that is high in carbohydrates. Hemoglobin is found inside the red blood cells and is exposed to glucose so that the glucose molecules adhere to the hemoglobin forming the glycosylated hemoglobin. The percentage of glycosylated hemoglobin depends on the blood glucose levels and the age of the red blood cells that carry the hemoglobin. Since the half-life of red blood cells is 3 months, a high percentage of this biomarker is indicative of a high blood glucose level over the last 3 months. Today HbA1C is used as a biomarker for diabetes and prediabetes as it is more accurate than fasting glucose testing. A value above 6.5% typically indicates diabetes, between 5.7% and 6.5% indicates prediabetes, below 5.7% is considered normal and the optimal value is below 5.1%.

Insulin is a hormone secreted by the pancreas when glucose levels increase after eating and allows glucose to enter the cells (especially the liver, brain and muscles) prior to use as energy. The amount of insulin required to maintain a certain level of blood glucose is an indicator of the resistance and sensitivity of cell receptors in the body to insulin. The measurement of fasting insulin for a given glucose level is often an important indicator of the level of resistance and/or sensitivity of cell receptors to the aforementioned hormone. A normal value should be below 25 mU/L, but a value of excellence is closer to 6 mU/L. The chances of developing diabetes are doubled with a basal insulin of 8 mU/L and multiplied 5-fold in cases where there is a basal insulin of 25 mU/L when compered to a value of 5 mU/L (2).

The strategies to maintain the three biomarkers at their respective levels of excellence are basically two-fold: regular exercise and a low glycemic index diet. Although it is not always easy to maintain a glucose level below 90 mg/dL, a HbA1c of approximately 5% and an insulin of around 6 mU/L is far from impossible. At the Neolife clinic most of our clients achieve their goal, which ensures they can enjoy a magnificent quality of life, health and a sense of well-being.

BIBLIOGRAPHY

(1) van Herpt, T., Stricker, B., Sijbrands, E. et al. “Lifetime risk of developing impaired glucose metabolism and eventual progression from prediabetes to type 2 diabetes: a prospective cohort study” The Lancet, Published Online: 10 November 2015

DOI: https://dx.doi.org/10.1016/S2213-8587(15)00362-9

https://www.thelancet.com/journals/landia/article/PIIS2213-8587(15)00362-9/abstract

(2) Johnson, JL., Duick, DS., Chui, MA, et al. “Identifying Prediabetes Using Fasting Insulin Levels”. Endocr Pract. 2010 Jan-Feb; 16(1):47-52.doi:10.4158/EP09031.OR.

La entrada Prevent diabetes: a priority for your future health se publicó primero en Neolife.

A recent study has shown that vitamin B supplementation can be used effectively to reduce brain atrophy and is more effective in individuals with high levels of omega 3.

The Preventive Anti-ageing Medicine recommends that individuals be subjected to regular neurocognitive tests in order to prevent neurocognitive deterioration. Such tests measure the homocysteine, determine the level of omega 3 fatty acids in the plasma and the erythrocyte membrane and can be used in order to prescribe both B vitamins and omega 3 supplements where appropriate.

Neolife medical management

A recent study has demonstrated that adequate supplementation with vitamin B and omega 3 can reduce the risk of brain atrophy by up to 70%.

Neurocognitive decline is an age-specific condition that is associated with brain atrophy and possibly with the development of Alzheimer’s disease. And it is widely understood that the concentrations of omega 3 and homocysteine in plasma are closely related to this specific type of atrophy and dementia.

More specifically that high plasma homocysteine levels are often associated with an increased risk of neurocognitive decline. A diet which does not contain sufficient amounts of B vitamins leads to B vitamin (B6 and B12) and folate (B9) deficiency which is the principal cause of high plasma homocysteine ​​levels. This situation requires supplementation in order to restore the neuroprotective effect these vitamins have in the body.

A recent study published in the American Journal of Clinical Nutrition (1) has demonstrated that supplementation with high doses of B vitamins is more effective in cases where the plasma omega 3 levels are maintained to a sufficient level. The work in question is the VITACOG study at the University of Oxford (United Kingdom) – this study included a randomized trial which compared 168 subjects divided into two groups; a control group (83 subjects) and the second group (85 subjects) who were treated with high doses of B vitamins for a two-year period. All of the subjects were over 70 years old and suffered a mild neurocognitive decline.

Previous results from the same VITACOG study published in 2010 (2) did show a reduction of up to 30% in brain atrophy in subjects who were treated with vitamin B when compared to the subjects in the placebo group. However, their omega 3 levels were unknown during the study.

The study reported in the current publication has confirmed that the effectiveness of vitamin B supplementation is dependent upon plasma omega 3 levels, so in subjects with higher omega 3 levels a greater protective effect is observed following the vitamin B treatment. In those subjects with low levels of omega 3, treatment with vitamin B had no neuroprotective effect, whilst those with high levels of omega 3 were shown to have a reduction in brain atrophy when measured by magnetic resonance imaging of between 40% and 70%, depending on the initial levels of homocysteine.

In an interview, Dr. Jenerén, the lead author of the study, confirmed that the determination of homocysteine levels is an important step in the prevention of neurocognitive decline and regrets that the NHS (British national health system) does not routinely provide for the determination of this biomarker.

Preventive Anti-ageing Medicine evaluates neurocognitive deterioration, homocysteine ​​and omega 3 in order to correct their levels by nutritional supplementation if necessary.

CNS neurocognitive testing, measurement of homocysteine, determination of plasma omega 3 and erythrocyte membrane levels, prescription of B vitamins as well as omega-3 supplements, are all nearly routine actions undertaken as part of Neolife protocols in relation to Preventive Anti-ageing Medicine.

Most of our patients during their first check-up have elevated or sub-optimal levels of homocysteine ​​and low or sub-optimal levels of omega 3, which is why we often supplement their diet with B vitamins and omega-3 fatty acids. Once the optimal levels of homocysteine ​​(below 9 micrmol/L) and omega 3 (IO3 above 8% and O6/O3 ratio below 3) have been achieved, the doses of said supplements are readjusted downwards. By taking such steps we ensure that we achieve genuine early prevention of neurocognitive decline and brain atrophy.

BIBLIOGRAPHY

(1) Jernerén F, Elshorbagy AK, Oulhaj A, et al. “Brain atrophy in cognitively impaired elderly: the importance of long-chain ω-3 fatty acids and B vitamin status in a randomized controlled trial“. Am J Clin Nutr. 2015 Jul;102(1):215-21. doi: 10.3945/ajcn.114.103283. Epub 2015 Apr 15.

https://www.ncbi.nlm.nih.gov/pubmed/25877495

(2) Smith AD, Smith SM, de Jager CA, et al. “Homocysteine-lowering by B vitamins slows the rate of accelerated brain atrophy in mild cognitive impairment: a randomized controlled trial“. Plos One. 2010 Sep 8;5(9):e12244. doi: 10.1371/journal.pone.0012244.

https://www.ncbi.nlm.nih.gov/pubmed/20838622

La entrada Homocysteine, vitamin B, omega 3 and neurocognitive prevention se publicó primero en Neolife.

A recent study published in JAMA concludes that providing financial incentives to both physicians and patients alike can improve compliance with the prescribed treatment.

The study consisted of checking compliance to prescribed treatments intended to lower LDL-cholesterol (bad cholesterol) levels in patients with a high risk of cardiovascular disease. The group in which both the physician and the patient were incentivized to adhere to the treatment to reduce the level of bad cholesterol (LDL) in 12 months by 36% more than the non-incentivized control group (34 mg/dL compared to a reduction of only 25 mg/dL for the control group).

Neolife medical management

Do we need incentives to achieve a proper health consciousness or is the reward of maintaining good health and a better quality of life more than enough?

We understand that the medicine we practice is an approach that is based on Age Management Medicine or Preventive Anti-ageing Medicine which is of limited interest to the majority of the population currently. Generally, most people who are interested in our services and treatments are acutely aware of their health and are therefore “health conscious” when it comes to adhering to beneficial lifestyles, or at least they try to adhere as far possible. Our clients are receptive to adopting new attitudes that improve their health and well-being and demand a significant amount of information to allow them to make their own decisions: that is to say, they are proactive. However, there are a very high percentage of people who are disinterested in taking care of their health and skeptical about the advice and treatments we propose. Some people still doubt that exercise is good for their health or that tobacco is actually harmful. We understand the psychological mechanisms of self-defense or self-justification which can prevent us from adopting a healthy attitude: a glass of wine a day is good (but in the end we drink half a bottle), too much exercise creates rust (but also if you do not get up from the chair!), everything makes me fat though I do not eat anything, it is not scientifically proven that…, etc.

The question amongst health professionals that are dedicated to promoting beneficial lifestyles and preventive treatments is what can we do to make these people realize the negative consequences of their poor habits and accept that they self-justify or that they can change their health. This is a question that falls firmly within the scope of psychology and is difficult for us to approach when we have such limited chance of being successful. It is very difficult to convert a “poor life styler” into a “health conscious” individual. But we should not throw in the towel and give up on these cases. We try to get our clients to adopt healthy attitudes little by little – such as preparing a proper breakfast, walking slightly more or taking nutritional supplements. Almost all those who are “unhealthy” are making small changes that do have a positive effect on their health and we can confirm these changes through monitoring tests. It is very important to celebrate such accomplishments, to give value to your achievements and reinforce your new healthy attitude. It is also advisable to outline reasonable objectives in the short and medium term and monitor compliance with the program we prescribe. Typically Neolife anti-ageing treatments involve analytical monitoring of the altered biomarkers every 3-6 months, although some biomarkers such as weight or fat percentage can be measured every 15 days (if necessary) and others such as telomere length or coronary calcium (calcium score) can be completed every 1-2 years. Each patient and their biomarkers have a unique past.

A recent study has demonstrated that economic incentives are a powerful ally for those who want to achieve health goals.

Within the same area of study we have been overwhelmed by a recent study published in JAMA (1) and financed by the National Institute on Ageing, which focused on the effect of an economic incentive on physicians and patients in North America when it comes to achieving their health goals. The aim was to see if an economic incentive could motivate the physician and the patient to comply with the treatment prescribed to lower the LDL-cholesterol (bad cholesterol) levels in the latter. The economic incentive for the physicians was $1,024 for each of their patients that reached their personal LDL-cholesterol target and the incentive for the patients provided them with the same amount. This was supplemented further by playing an ingenious internal lottery system in which the participants could win a prize if they had taken the pill from the previous day. The study included 304 family physicians and 1,503 of their patients with high risk of cardiovascular disease, who were divided into four groups:

• Control group: no incentive was offered.
• Incentive for the physician.
• Incentive for the patient.
• Incentive for the physician and the patient.

The average decrease in LDL-cholesterol levels 12 months after commencement of the study was 25 mg/dL for the control group, 28 mg/dL for the incentivized physician group, 25 mg/dL for the incentivized patient group and 34 mg/dL for the incentivized physician and patient group. Therefore, the best treatment compliance was from the group in which both the physician and the patient were incentivized. The authors of the study recognize that these types of strategies may not be economically viable in the short term but argue that perhaps the future savings in costly medical interventions compensate for the initial investment and outlay in incentivizing compliance in such a way.

At Neolife we believe that such strategies are at least unique and deserve discussion given our socio-economic environment as they offer an opportunity for us to reflect on how to improve health in a cost effective way. From the results of the study one could conclude that one takes care of his or her own health if they make money and that the physician only perseveres in the health of his or her patients if they earn more money. We prefer to think of the results as evidence that we are able to assume healthy attitudes with the only and not inconsiderable reward of maintaining our good health and quality of life.

BIBLIOGRAPHY

(1) Asch, D. Troxel, A, Stewart, W, et al. “Effect of Financial Incentives to Physicians, Patients, or Both on Lipid Levels, A Randomized Clinical Trial”. JAMA. 2015;314(18):1926-1935. doi:10.1001/jama.2015.14850.
https://jama.jamanetwork.com/article.aspx?articleid=2468891

La entrada Can health consciousness be achieved? se publicó primero en Neolife.